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EBMeDS and HL7 FHIRFHIR Application Roundtable, Kuntatalo, Helsinki 18.9.2017
EBMeDSan introduction
EBMeDS
• EBMeDS is a Clinical Decision Support System (CDSS)• matches individual patient data with evidence-based recommendations
(knowledge) that would benefit the patient
• provides actionable guidance automatically at the right time, in the right format at the right point in the workflow
• Integrated to all major EHR/EMR systems in Finland. Current coverage is over 50 % of doctors and nurses in public healthcare, and growing.
EBMeDS is automatic and integrated
• Embedded as part of EHR user interface
• Reminds and warns automatically of significant findings related to patient’s care. CDS takes into consideration• Age, gender, pregnancy, lactation and smoking status• Medication• Conditions• Laboratory results and physical measurements• Vaccinations• Procedures• ..and more
Example of generic reminders
Diabetes (E11.9)Coronary disease (I20.8)
BP: 145/90 mmHgPotassium: 6.1 mmol/l
EBMeDSUsing HL7 FHIR for Clinical Decision Support
Use of HL7 FHIR in EBMeDS
• HL7 FHIR has several characteristics that can benefit Clinical Decision Support• Internationally acknowledged
• Increasingly popular
• Less of data useless to CDSS (vs. CDA, HL7 v3)
• Two types of solutions are under development• CDS Hooks based (typically automatic) CDS service
• SMART on FHIR apps
CDS Hooks in short
• CDS Hooks are events in the professional’s or citizen’s workflow that trigger a query to the CDSS
• The CDSS returns cards that contain information, suggestions, links and possible actionable items (activityDefinition)
• Prefetch templates define what data is needed for each type of query, and boost performance
www.cds-hooks.org
CDS Hooks benefits
• Deeper integration with professional’s workflow
• Expected to become an international standard for CDSS• Potential to create a new ecosystem, where EHR client can choose to license
CDS Hooks from many different providers
• There is however some uncertainty about what will happen in STU4
• EBMeDS CDS Hook catalog is open for viewing https://ebmeds.github.io/api-gateway/
CDS Hooks – Focus on the workflow
Open patientrecord
Focus on a
diagnosis
Createlab order
Order drug
Renewprescripti
on
EBMeDS CDSS
CDS Hooks catalog
CDS Hooks example
Createlab order
Lab order x recommend
ed. Order now?
Adddiagnosis
EBMeDS CDSS
CDS Hook• new-diagnosis
CDS Card(s)• text• activityDefinition• etc.
Prefetch template• Observation• Condition• Medication• Etc.
ActivityDefinition(s)• Observation
carePlan
SMART on FHIR apps
• Initiated on-demand from the EHR
• Two demos implemented• Comprehensive Medication
Review
• Finrisk calculator
• Communication between the EHR and the app can be bidirectional
For more information
joonas.makinen [at] duodecim.fi
http://www.ebmeds.org